Dear Diary, what should I say? – journaling and end of life planning

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At some point in our lives, hidden deep within the darkest recesses of a long forgotten closet, or burned in some kind of coming of age ritual, many of us had once kept a secret diary (or journal, call it what you will).

These diaries, according to general public opinion, consist of inane factoids of daily life and the swooning and angst of infatuation, all predicated on the mythological image of sparkly pink covers and padlocks that get picked by nosy siblings and love interests.

However banal these entries may have been in retrospect, the process of writing whenever a moment in life struck you as something unique, provided an opportunity for self-reflection, of recognizing that something has changed, that this subject matter had formative impact.

Requisitioning time to think

But in the rush of our perpetually busy lives, it’s all too easy to compartmentalise what is business and what is personal, to shove small crises and epiphanies in the back of our mind until we have the time to ponder them – which we invariably don’t – or forget them altogether.

Sometimes it seems as if we live from moment to moment, trapped in the present of ticking clocks, piling papers, overfilled planners – the horror vacui of the past has been eliminated by strict regimentation of each day (“metro, bulot, dodo” [train, work, sleep]), of each arc of life (schooling, work, retirement).

Surely this sort of automization of living is not that bad, for predictability is safety, routine is comforting.

But we do say that “life happens.”

We buy insurance on the off chance that our cars might get totaled, our houses swept away, our bodies ravaged by illness or accident.

We might be ‘protected’ should these crises arise, but being financially covered to a certain extent does not directly translate to being prepared emotionally, spiritually, personally.

We’ve requisitioned time to think about our lives, our values, what matters most to us, to a few more hours behind the screen, the desk, the wheel. In some sense, we’ve lost track of who we are without these activities that fill up our schedules.

Our perception of time, based on how much life we perceive we have left, determine how we set our goals; thus, an indefinite future results in more knowledge-acquisition based goals and a finite end results in primarily emotional goals (Carstensen).

A shortened and definitive time horizon leads to choices that invest in deeply personal and meaningful experiences – things that we would never allow ourselves to yield to when the future stretches farther than we can see, and everything must fall into our life plan.

The shifting importance of emotional goals

This gradual increase of importance placed on emotional goals as we age is reasonable, certainly, but not at all ideal – should our lives be abruptly cut short, we are left hanging on a precipice of internal and external turmoil, unprepared to transition and adjust our perception of who we are and what we want.

When I asked my peers (ages 19-26) what they would do if they had one year left to live, almost everyone expressed that they would like to travel the world or indulge in pleasure that had not previously allowed themselves to indulge in; many wanted to spend time with family and loved ones; all would quit their job. When this time horizon was shortened to one hour, responses were exclusively directed towards expressing gratitude for and spending time with loved ones.

When I asked seniors living at assisted living facilities questions to invoke reflections about their life and death (derived from Chochinov’s Dignity Therapy model and Friedrich Nietzsche’s concept of the “Greatest Weight” and the “eternal recurrence”), the majority were direct and certain in their answers – in general, they had already said the things they wished to say to their loved ones, and were distinctly aware of their values and what they wanted out of the remainder of their lives.

It seemed to me that the elderly are, in a sense, more prepared for end of life situation because of their shortened time horizons, and their increased self-awareness and mindfulness. Asking a younger cohort resulted in much greater uncertainty, slight discomfort.

This is not just a matter of age and experience, however, for the amount of self-reflection each individual has done in their life, at any age, greatly determines ability to answer such questions – familiarity with the self comes with practice and preparation.

Our perception of life is based on age, and gaining enough experience to level up from sequential transitional stages. But this is all too vulnerable to contingencies that can (and often do) happen. 

Especially in the case of end of life situations, our ability to shift our goals and perspectives becomes paramount; given the abruptness of a dire prognosis, it is all the more important that we have practiced and honed this skill.

Differing perspectives on time horizons can come into conflict when decisions need to be made over the course of action during end of life planning.

Reinstating the journal

So do I propose that we reinstate the journal to its former office in our lives.

At the time of prognosis, a patient could be given a defined space to make meaning of aspects of their life and to better grasp what they value and what they want for the future.

This refines communication between parties about life goals, histories, and values that might otherwise be forgotten or disregarded as trivial.

By asking these questions about life that might otherwise be disregarded until one can “find the time” to think about them, all parties involved are given an opportunity to pause, to evaluate who they have been, who they are, who they want to be.

If the patient is clearly aware of their values and needs, they will be better able to make their own decisions and communicate on equal footing with their physicians and loved ones. In the bereavement process, journaling would be an incredible asset in redefining time frame and life values.

Journaling is a practice that is invaluable at any time of life, whether we begin with doodles and nonsensical ramblings or with long-form poetry and monologues.

It keeps us grounded in our own world, our sense of self – allows us to chronicle our experiences, fears and aspirations.  

Our goal is to create a time and space dedicated solely to deep self-reflection and evaluation of what we value, what we want, what matters most to us in life.

We cannot continue to maintain our current breakneck pace without giving ourselves time to think. “Life doesn’t stop for anybody,” said Charlie, in Stephen Chbosky’s novel, The Perks of Being a Wallflower, but that doesn’t mean that we must let ourselves be swept away by our constant push to move forward relentlessly.

We must scribble in those forgotten pages once more, with or without the pink glitter and poorly fashioned lock, secret or not.

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